U.S. patent number 5,476,514 [Application Number 08/020,630] was granted by the patent office on 1995-12-19 for accommodating intraocular lens.
Invention is credited to J. Stuart Cumming.
United States Patent |
5,476,514 |
Cumming |
December 19, 1995 |
**Please see images for:
( Certificate of Correction ) ** |
Accommodating intraocular lens
Abstract
An accommodating intraocular lens to be implanted within the
natural capsular bag of a human eye from which the natural lens
matrix has been removed through an anterior capsulotomy in the bag
circumferentially surrounded by a capsular remnant. During a
postoperative healing period following surgery, the anterior
capsular remnant fuses to the posterior capsule of the bag by
fibrosis about haptics on the implanted lens, and the lens is
deflected rearwardly to a distant vision position against the
elastic posterior capsule of the bag in which the posterior capsule
is stretched rearwardly. After fibrosis is complete, natural
brain-induced contraction and relaxation of the ciliary muscle
relaxes and stretches the fused remnant and increases and reduces
vitreous pressure in the eye to effect vision accommodation by the
fused remnant, the posterior capsule, and vitreous pressure. A
method of utilizing the intraocular lens in a human eye to provide
the eye with accommodation and to enable utilization of a lens with
a relatively large optic.
Inventors: |
Cumming; J. Stuart (Anaheim,
CA) |
Family
ID: |
27361477 |
Appl.
No.: |
08/020,630 |
Filed: |
February 22, 1993 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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915453 |
Jul 16, 1992 |
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515636 |
Apr 27, 1990 |
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Current U.S.
Class: |
623/6.37 |
Current CPC
Class: |
A61F
2/1629 (20130101); B29D 11/026 (20130101); A61F
2002/1689 (20130101) |
Current International
Class: |
A61F
2/16 (20060101); A61F 002/16 () |
Field of
Search: |
;623/6 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Spencer Thornton, "Accommodating in Pseudophakia", Color Atlas of
Lens Implantation, Chapter 25, pp. 159-162..
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Primary Examiner: Shay; Randy C.
Attorney, Agent or Firm: Kenyon & Kenyon
Parent Case Text
REFERENCE TO RELATED APPLICATIONS
This application is a continuation-in-part of my application Ser.
No. 07/915,453, filed Jul. 16, 1992, now abandoned, which, in turn,
is a continuation-in-part of my application Ser. No. 07/515,636,
filed Apr. 27, 1990, now abandoned. Reference is also made to my
application Ser. No. 07/744,472 filed Aug. 12, 1991.
Claims
What is claimed is:
1. An accommodating intraocular lens to be implanted within a human
eye having a natural capsular bag attached about its perimeter to
the ciliary muscle of the eye and from which the natural lens
matrix has been removed, the bag including an elastic posterior
capsule urged anteriorly by vitreous pressure in the eye and an
anterior capsulotomy circumferentially surrounded by a capsular
remnant having epithelial cells on its posterior side which cause
fusion of the remnant to the posterior capsule by fibrosis during a
certain postoperative period following implantation of the lens in
the eye, said intraocular lens comprising:
a lens body having normally anterior and posterior sides and
including an optic and plate haptics which extend from two
diametrically opposite edges of said optic and have inner ends
joined to the optic and opposite outer ends which are movable
anteriorly and posteriorly relative to said optic, wherein said
lens body includes hinges joining the inner ends of said haptics to
said optic about which said haptics are pivotally movable
anteriorly and posteriorly relative to said optic, wherein said
lens body contains grooves in at least one of said body sides along
the inner ends of said haptics forming flexible, reduced thickness
portions of the lens body which constitute said hinges, and
wherein
said intraocular lens is sized to be implanted within said capsular
bag when the ciliary muscle is paralyzed in its relaxed state and
in a position wherein the outer ends of said haptics are disposed
between said capsular remnant and the outer perimeter of said
posterior capsule and said optic is aligned with said anterior
capsulotomy to permit fibrosis about the haptics of the implanted
lens during said post-operative period in such a way that after
fibrosis is complete, relaxation of the ciliary muscle effects
posterior movement of the implanted lens and constriction of the
ciliary muscle effects anterior accommodation of the implanted
lens.
2. An accommodating intraocular lens comprising:
a lens body having normally anterior and posterior sides and
including an optic, and plate haptics extending from opposite edges
of said optic and having inner ends adjacent said optic and
opposite outer ends, wherein
said intraocular lens includes hinge means pivotally joining said
inner haptic ends to said optic for pivotal movement of said
haptics about said hinge means anteriorly and posteriorly relative
to said optic, wherein said hinge means comprise flexible hinge
portions of said lens body, and wherein
said hinge portions comprise reduced thickness portions of said
lens body formed by grooves in at least one of said body sides.
3. An accommodating intraocular lens to be implanted within a human
eye having a natural capsular bag attached about its perimeter to
the ciliary muscle of the eye and from which the natural lens
matrix has been removed, the bag including an elastic posterior
capsule urged anteriorly by vitreous pressure in the eye and an
anterior capsulotomy circumferentially surrounded by a capsular
remnant having epithelial cells on its posterior side which cause
fusion of the remnant to the posterior capsule by fibrosis during a
certain postoperative period following implantation of the lens in
the eye, said intraocular lens comprising:
a lens body having normally anterior and posterior sides and
including an optic and plate haptics which extend from two
diametrically opposite edges of said optic and have inner ends
joined to the optic and opposite outer ends which are movable
anteriorly and posteriorly relative to said optic, wherein
said intraocular lens includes springs at the outer ends of said
haptics having normal unstressed positions wherein said springs
extend beyond their adjacent outer haptic ends in the endwise
directions of the haptics for resilient engagement with the
perimeter of said bag to firmly position the lens in the bag during
fibrosis and prevent dislocation of the lens in the bag if said
capsular remnant is torn, slit, or otherwise ruptured during
surgery or fibrosis, wherein
said springs comprise spring loops having base ends fixed to said
haptics and opposite free ends, and each spring loop curves
outwardly from the outer end of its respective haptic in the
endwise direction of the haptic and laterally of the haptic from
the base end to a certain position along the respective loop and
then back toward the outer end of the respective haptic from said
certain position to said free end of the respective haptic and
wherein
said intraocular lens is sized to be implanted within said capsular
bag when the ciliary muscle is paralyzed in its relaxed state and
in a position wherein the outer ends of said haptics are disposed
between said capsular remnant and the outer perimeter of said
posterior capsule and said optic is aligned with said anterior
capsulotomy to permit fibrosis about the haptics of the implanted
lens during said postoperative period in such a way that after
fibrosis is complete, relaxation of the ciliary muscle effects
posterior movement of the implanted lens and constriction of the
ciliary muscle effects anterior accommodation of the implanted
lens.
4. An accommodating intraocular lens to be implanted within a human
eye having a natural capsular bag attached about its perimeter to
the ciliary muscle of the eye and from which the natural lens
matrix has been removed, the bag including an elastic posterior
capsule urged anteriorly by vitreous pressure in the eye and an
anterior capsulotomy circumferentially surrounded by a capsular
remnant having epithelial cells on its posterior side which cause
fusion of the remnant to the posterior capsule by fibrosis during a
certain postoperative period following implantation of the lens in
the eye, said intraocular lens comprising:
a lens body having normally anterior and posterior sides and
including an optic and plate haptics which extend from two
diametrically opposite edges of said optic and have inner ends
joined to the optic and opposite outer ends which are movable
anteriorly and posteriorly relative to said optic, wherein
said intraocular lens includes springs at the outer ends of said
haptics having normal unstressed positions wherein said springs
extend beyond their adjacent outer haptic ends in the endwise
directions of the haptics for resilient engagement with the
perimeter of said bag to firmly position the lens in the bag during
fibrosis and prevent dislocation of the lens in the bag if said
capsular remnant is torn, slit, or otherwise ruptured during
surgery or fibrosis, wherein
said springs comprise a single spring loop on the outer end of each
haptic having a base end fixed to the respective haptic adjacent
one longitudinal edge of the haptic and opposite free end, the base
ends of the haptics are situated adjacent opposite longitudinal
edges of the haptics, and each spring loop curves outwardly from
the outer end of its respective haptic in the endwise direction of
the haptic and laterally of the haptic from its base end to a
certain position along the respective loop and then back toward the
outer end of the respective haptic from said certain position to
said free end of the respective haptic and wherein
said intraocular lens is sized to be implanted within said capsular
bag when the ciliary muscle is paralyzed in its relaxed state and
in a position wherein the outer ends of said haptics are disposed
between said capsular remnant and the outer perimeter of said
posterior capsule and said optic is aligned with said anterior
capsulotomy to permit fibrosis about the haptics of the implanted
lens during said postoperative period in such a way that after
fibrosis is complete, relaxation of the ciliary muscle effects
posterior movement of the implanted lens and constriction of the
ciliary muscle effects anterior accommodation of the implanted
lens.
5. An accommodating intraocular lens comprising:
a lens body having normally anterior and posterior sides and
including an optic, and plate haptics extending from opposite edges
of said optic and having inner ends adjacent said optic and
opposite outer ends, wherein
said intraocular lens includes springs at the outer ends of said
haptics having normal unstressed positions wherein said springs
extend beyond their adjacent outer haptic ends in the endwise
directions of the haptics for resilient engagement with the
perimeter of said bag to firmly position the lens in the bag during
fibrosis and prevent dislocation of the lens in the bag if said
capsular remnant is torn, slit, or otherwise ruptured during
surgery or fibrosis, wherein
said springs comprise spring loops having base ends fixed to said
haptics and opposite free ends, and each spring loop curves
outwardly from the outer end of its respective haptic in the
endwise direction of the haptic and laterally of the haptic from
the base end to a certain position along the respective loop and
then back toward the outer end of the respective haptic from said
certain position to said free end of the respective haptic, and
wherein
said intraocular lens includes hinge means pivotally joining said
inner haptic ends to said optic for pivotal movement of said
haptics about said hinge means anteriorly and posteriorly relative
to said optic such that when said intraocular lens is fixed within
a capsular bag of the eye between a posterior capsule of the
capsular bag and a remnant of an anterior capsule of the capsular
bag, said lens deflects anteriorly when the eye focuses on near
objects and said lens deflects posteriorly when the eye focuses on
distant objects.
6. An accommodating intraocular lens comprising:
a lens body having normally anterior and posterior sides and
including an optic, and plate haptics extending from opposite edges
of said optic and having inner ends adjacent said optic and
opposite outer ends, wherein
said intraocular lens includes springs at the outer ends of said
haptics having normal unstressed positions wherein said springs
extend beyond their adjacent outer haptic ends in the endwise
directions of the haptics for resilient engagement with the
perimeter of said bag to firmly position the lens in the bag during
fibrosis and prevent dislocation of the lens in the bag if said
capsular remnant is torn, slit, or otherwise ruptured during
surgery or fibrosis, wherein
said springs comprise a single spring loop on the outer end of each
haptic having a base end fixed to the respective haptic adjacent
one longitudinal edge of the haptic, and an opposite free end,
wherein
the base ends of the springs are situated adjacent opposite
longitudinal edges of the haptics, wherein
each spring loop curves outwardly from the outer end of its
respective haptic in the endwise direction of the haptic and
laterally of the haptic from its base end to a certain position
along the respective loop and then back toward the outer end of the
respective haptic from said certain position to said free end of
the respective haptic, and wherein
said intraocular lens includes hinge means pivotally joining said
inner haptic ends to said optic for pivotal movement of said
haptics about said hinge means anteriorly and posteriorly relative
to said optic such that when said intraocular lens is fixed within
a capsular bag of the eye between a posterior capsule of the
capsular bag and a remnant of an anterior capsule of the capsular
bag, said lens deflects anteriorly when the eye focuses on near
objects and said lens deflects posteriorly when the eye focuses on
distant objects.
7. An accommodating intraocular lens adapted to be implanted within
a human eye having a natural capsular bag attached about its
perimeter to the ciliary muscle of the eye and from which the
natural lens matrix has been removed, the bag including an elastic
posterior capsule urged anteriorly by vitreous pressure and an
anterior capsulotomy circumferentially surrounded by a capsular
remnant fused by fibrose tissue to the posterior capsule, said lens
comprising:
an intraocular lens having normally anterior and posterior sides
and including a central optic, and haptics extending from opposite
edges of the optic and having inner ends joined to the optic and
opposite outer ends movable anteriorly and posteriorly relative to
said optic, wherein
said lens includes hinges joining the inner ends of said haptics to
said optic and about which said haptics are pivotally movable
anteriorly and posteriorly relative to said optic, wherein
said lens contains grooves in one of said lens sides along the
inner ends of said haptics forming flexible, reduced thickness
portions of the lens which constitute said hinges, and wherein
said intraocular lens is adapted to be situated within said
capsular bag in a position wherein said optic is aligned with said
capsulotomy and the outer ends of said haptics are disposed between
said anterior capsule rim and the outer perimeter of said posterior
capsule and confined within pockets in the fibrose tissue in a
manner such that relaxation of the ciliary muscle effects posterior
deflection of the lens and constriction of the ciliary muscle
effects anterior accommodation of the lens.
8. An accommodating intraocular lens for insertion through an
opening formed by capsulorhexis in an anterior capsule of a
capsular bag of an eye for fixation adjacent to a posterior capsule
of the capsular bag comprising:
a central optic portion having an anterior surface and a posterior
surface; and
a plurality of extended portions extending radially from the
central optic portion, each extended portion having a proximate end
connected to the central optic portion and a distal end remote from
the proximate end, each extended portion adapted to permit the lens
to fit within the opening formed in the anterior capsule and to
permit fixation of the intraocular lens, said extended portions
adapted to rearwardly deflect the central optic portion against the
posterior capsule under ciliary muscle relaxation, to forwardly
deflect the central optic portion under ciliary muscle
constriction, and to bias the central optic portion against the
posterior capsule during a substantial portion of its movement,
resulting in consistent accommodation of the implanted lens with
said restriction and relaxation of the ciliary muscle.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates generally to intraocular lenses and more
particularly to novel accommodating intraocular lenses for
implantation within the capsular bag of a human eye from which the
natural lens matrix has been removed by an extraction procedure
which leaves intact within the eye the posterior capsule and an
anterior capsule remnant of the natural lens. The invention relates
also to a novel method of utilizing the intraocular lenses in a
human eye to provide the patient with accommodation capability
responsive to normal ciliary muscle action.
2. Prior Art
The human eye has an anterior chamber between the cornea and the
iris, a posterior chamber behind the iris containing a crystalline
lens, a vitreous chamber behind the lens containing vitreous humor,
and a retina at the rear of the vitreous chamber. The crystalline
lens of a normal human eye has a lens capsule attached about its
periphery to the ciliary muscle of the eye by zonules and
containing a crystalline lens matrix. This lens capsule has elastic
optically clear anterior and posterior membrane-like walls commonly
referred by ophtalmologists as anterior and posterior capsules,
respectively. Between the iris and ciliary muscle is an annular
crevice-like space called the ciliary sulcus.
The human eye possesses natural accommodation capability. Natural
accommodation involves relaxation and constriction of the ciliary
muscle by the brain to provide the eye with near and distant
vision. This ciliary muscle action is automatic and shapes the
natural crystalline lens to the appropriate optical configuration
for focussing on the retina the light rays entering the eye from
the scene being viewed.
The human eye is subject to a variety of disorders which degrade or
totally destroy the ability of the eye to function properly. One of
the more common of these disorders involves progressive clouding of
the natural crystalline lens matrix resulting in the formation of
what is referred to as a cataract. It is now common practice to
cure a cataract by surgically removing the cataractous human
crystalline lens and implanting an artificial intraocular lens in
the eye to replace the natural lens. The prior art is replete with
a vast assortment of intraocular lenses for this purpose. Examples
of such lenses are described in the following U.S. Pat. Nos.:
4,254,509, 4,298,996, 4,409,691, 4,424,597, 4,573,998, 4,664,666,
4,673,406, 4,738,680, 4,753,655, 4,778,463, 4,813,955, 4,840,627,
4,842,601, 4,963,148, 4,994,082, 5,047,051.
As is evident from the above patents, intraocular lenses differ
widely in their physical appearance and arrangement. This invention
is concerned with intraocular lenses of the kind having a central
optical region or optic and haptics which extend outward from the
optic and engage the interior of the eye in such a way as to
support the optic on the axis of the eye. My above-listed U.S. Pat.
No. 5,047,051, which was filed concurrently with my earlier
mentioned application Ser. No. 07/515,636, discloses an intraocular
lens having a haptic anchor plate, an optic at the longitudinal
center of the plate, and resilient haptic loops staked to the ends
of the plate.
Up until the late 1980's, cataracts were surgically removed by
either intracapsular extraction involving removal of the entire
human lens including both its outer lens capsule and its inner
crystalline lens matrix, or by extracapsular extraction involving
removal of the anterior capsule of the lens and the inner
crystalline lens matrix but leaving intact the posterior capsule of
the lens. Such intracapsular and extracapsular procedures are prone
to certain post-operative complications which introduce undesirable
risks into their utilization. Among the most serious of these
complications are opacification of the posterior capsule following
extracapsular lens extraction, intraocular lens decentration,
cystoid macular edema, retinal detachment, and astigmatism.
Starting in the late 1980's, an improved surgical procedure called
capsulorhexis (a form of anterior capsulotomy) was developed to
alleviate or avoid the above and other post-operative complications
and risks involved in intracapsular and extracapsular cataract
extraction. Simply stated, capsulotomy involves forming an opening
in the anterior capsule of the natural lens, leaving intact within
the eye a capsular bag having an elastic posterior capsule, an
anterior capsular remnant about the anterior capsulotomy, and an
annular sulcus, referred to herein as a capsular bag sulcus,
between the anterior capsule remnant and the outer circumference of
the posterior capsule. This capsular bag remains attached about its
periphery to the surrounding ciliary muscle of the eye by the
zonules of the eye. The cataractous natural lens matrix is
extracted from the capsular bag through the anterior capsulotomy by
phacoemulsification and aspiration or in some other way after which
an intraocular lens is implanted within the bag through the
capsulotomy.
The type of anterior capsulotomy known as capsulorhexis involves a
continuous tear circular or round capsulotomy, tearing the anterior
capsule of the natural lens capsule along a generally circular tear
line substantially coaxial with the lens axis and removing the
generally circular portion of the anterior capsule surrounded by
the tear line. A continuous tear circular capsulorhexis, if
performed properly, provides a generally circular capsulotomy
through the anterior capsule of the natural lens capsule
substantially coaxial with the axis of the eye and surrounded
circumferentially by a continuous annular remnant or rim of the
anterior capsule having a relatively smooth and continuous inner
edge bounding the capsulotomy. During a continuous tear circular
capsulorhexis, however, the anterior rim is often accidentally torn
or sliced radially or otherwise ruptured, or the inner rim edge is
nicked or sliced in a manner which renders the rim prone to tearing
radially when the rim is stressed, as it is during fibrosis as
discussed below.
Another capsulorhexis procedure, referred to as an envelope
capsulorhexis, involves cutting a horizontal incision in the
anterior capsule of the natural lens capsule, then cutting two
vertical incisions in the anterior capsule intersecting and rising
from the horizontal incision, and finally tearing the anterior
capsule along a tear line having an upper upwardly arching portion
which starts at the upper extremity of the vertical incision and
continues in a downward vertical portion parallel to the vertical
incision which extends downwardly and then across the second
vertical incision. This procedure produces in the anterior capsule
a generally archway-shaped envelope capsulotomy centered on the
axis of the eye. The capsulotomy is bounded at its bottom by the
horizontal incision, at one vertical side by the vertical incision,
at its opposite vertical side by the second vertical incision of
the anterior capsule, and at its upper side by the upper arching
portion of the capsule tear. The vertical incision and the adjacent
end of the horizontal incision form a flexible flap at one side of
the capsulotomy. The vertical tear edge and the adjacent end of the
horizontal incision form a second flap at the opposite side of the
capsulotomy.
Yet another capsulorhexis procedure, referred to as a beer can or
can opener capsulorhexis, involves piercing the anterior capsule of
the natural lens capsule at a multiplicity of intersecting
positions along a circular line substantially coaxial with the axis
of the eye and then removing the generally circular portion of the
capsule circumferentially surrounded by the line. This procedure
produces a generally circular capsulotomy substantially coaxial
with the axis of the eye and bounded circumferentially by an
annular remnant or rim of the anterior capsule. The inner edge of
this rim has a multiplicity of scallops formed by the edges of the
pierced holes in the anterior capsule which render the annular
remnant or rim prone to tearing radially when the rim is stressed,
as it is during fibrosis as discussed below.
Intraocular lenses also differ with respect to their accommodation
capability, and their placement in the eye. Accommodation is the
ability of an intraocular lens to accommodate, that is to focus the
eye for near and distant vision. My application Ser. No. 07/744,472
and some of the earlier listed patents describe accommodating
intraocular lenses. Others of the listed patents describe
non-accommodating intraocular lenses. Most non-accommodating lenses
have single focus optics which focus the eye at a certain fixed
distance only and require the wearing of eye glasses to change the
focus. Other non-accommodating lenses have bifocal optics which
image both near and distant objects on the retina of the eye. The
brain selects the appropriate image and suppresses the other image,
so that a bifocal intraocular lens provides both near vision and
distant vision sight without eyeglasses. Bifocal intraocular
lenses, however, suffer from the disadvantage that each bifocal
image represents only about 40% of the available light and the
remaining 20% of the light is lost in scatter.
There are four possible placements of an intraocular lens within
the eye. These are (a) in the anterior chamber, (b) in the
posterior chamber, (c) in the capsular bag, and (d) in the vitreous
chamber. The intraocular lens disclosed in my application Ser. No.
07/744,472 is intended for placement within the capsular bag.
SUMMARY OF THE INVENTION
According to one of its aspects, this invention provides improved
plate haptic accommodating intraocular lenses to be implanted
within the capsular bag of a human eye which remains in the eye
after removal of the natural matrix from the human lens capsule
through an anterior capsulotomy produced by a capsulorhexis
procedure. An improved accommodating intraocular lens according to
the invention has a central optic and two plate haptics which
extend generally radially outward from diametrically opposite sides
of the optic and are movable anteriorly and posteriorly relative to
the optic. The width of the plate optics is substantially the same
as the diameter of the optic. In some described lens embodiments,
the plate haptics are relatively stiff, their inner ends are hinged
to the optic, and the anterior/posterior movement Of the haptics
involves pivotal movement of the haptics at their hinges. In other
described embodiments, the plate haptics are resiliently flexible,
and the anterior/posterior movement of the haptics relative to the
optic involves resilient flexing or bending of the haptics
throughout their length. In this regard, it is important to note
that the terms "flex", "flexing", "flexible", and the like are used
herein in a broad sense to cover both hinged and resiliently
bendable haptics. According to an embodiment of the invention, the
lens body is constructed of a material having an elastic memory,
and the lens body has an unstressed configuration in which the
haptics, optic and hinge means are disposed substantially in a
common plane.
Certain of the described lens embodiments, referred to as simple
plate haptic lenses, are intended for use when the capsularhexis
procedure utilized in cataract surgery is a properly performed
continuous tear circular capsulotomy, which provides an anterior
capsulotomy circumferentially surrounded by an anterior capsule
remnant in the form of an intact, circumferentially continuous
annular rim that remains free of splits and tears throughout
fibrosis following surgery. A simple plate haptic lens of the
invention is implanted within the eye in a position wherein the
lens optic is aligned on the axis of the eye with the anterior
capsulotomy and the outer ends of the plate haptics are situated
within the capsular bag sulcus in contact with the sulcus wall. The
normally posterior side of the lens then faces the elastic
posterior capsule of the bag.
During a post operative healing period on the order of three weeks,
active endodermal cells on the posterior side of the anterior
capsular rim cause fusion of the rim to the elastic posterior
capsule by fibrosis. Fibrosis occurs about the haptics in such a
way that the haptics are effectively "shrink-wrapped" by the
capsular bag and form radial pockets between the anterior rim and
the posterior capsule. These pockets contain the haptics and act to
position and center the lens in the eye. The anterior capsular rim
shrinks during fibrosis. This shrinkage combined with
shrink-wrapping of the haptics causes endwise compression of the
lens in a manner which tends to deflect the center of the lens
along the axis of the eye relative to the fixated outer haptic
ends. The intact fibrosed capsular rim prevents forward deflection
of the lens, so that fibrosis-induced deflection of the lens occurs
rearwardly to a position in which the lens presses against the
elastic posterior capsule and stretches this capsule
rearwardly.
In order to insure proper formation of the haptic pockets during
fibrosis, brain-induced flexing of the lens during fibrosis is
prevented by using a ciliary muscle relaxant, such as Atropine
drops, to maintain the ciliary muscle in a relaxed state and/or
using a suture to physically prevent flexing of the lens. In the
Atropine-induced relaxed state of the ciliary muscle, the capsular
bag is stretched to its maximum diameter. The anterior capsular rim
is then stretched to a taut trampoline-like condition or position
in which the rim prevents forward flexing of lens from its
posterior position against the posterior capsule. The rim undergoes
fibrosis from this taut condition or position.
Use of the ciliary muscle relaxant is discontinued upon completion
of fibrosis. Thereafter, when the brain activates the ciliary
muscle to its natural relaxed state, the capsular bag and the
fibrosed anterior capsular rim are stretched, the rim to its taut
trampoline-like condition in which the rim deflects the lens
rearwardly to and holds the lens in its posterior position. In this
position of the lens, which is its distant vision position, it
presses rearwardly against and stretches the elastic posterior
capsule. The stretched posterior capsule then exert a forward bias
force on the lens.
The plate haptic lenses of the invention are uniquely constructed
and arranged to utilize the fibrosed anterior capsular rim, the
elastic posterior capsule, the vitreous cavity pressure, and the
natural brain-controlled ciliary muscle action of the eye to
provide postoperative accommodation for near vision. Thus, when
looking at a near object, the brain constricts the ciliary muscle.
This relaxes the fibrosed anterior rim, increases vitreous cavity
pressure, and compresses the lens endwise in such a way as to
effect forward deflection, i.e. accommodation movement, of the lens
optic along the axis of the eye to a near vision position.
Depending upon the amount of accommodation, accommodation
deflection of the lens is produced initially by the increase in
viteous pressure and the forward bias force of the stretched
posterior capsule and finally by forward buckling of the lens in
response to endwise compression of the lens. Subsequent
brain-activated relaxation of the ciliary muscle stretches the
capsular bag and the fibrosed anterior capsular rim to return the
lens rearwardly toward its distant vision position.
A plate haptic lens according to the invention may have a normal
unstressed configuration, such that when deflected from this normal
unstressed configuration, the lens develops internal elastic strain
energy forces which bias the lens toward its normal unstressed
configuration in a manner which aids accommodation. The lens may be
generally flat, anteriorly arched, or posteriorly arched in this
normal unstressed configuration. One disclosed embodiment of the
lens includes auxiliary springs for aiding lens accommodation. Some
disclosed lens embodiments have integral fixation means at the
haptic ends around which fibrosis of the anterior rim of the
capsular bag occurs to fix the lens against dislocation in the eye.
Other disclosed embodiments have fixation elements from which the
lens proper is separable to permit later removal of the lens for
repair or correction and replacement of the lens in its exact
original position within the eye.
The simple plate haptic lenses discussed above are intended for use
when the capsulorhexis procedure performed on the eye provides an
anterior capsular remnant or rim that remains intact and
circumferentially continuous throughout fibrosis. According to
another of its aspects, this invention provides modified
accommodating intraocular lenses, referred to as plate haptic
spring intraocular lenses, for use when the anterior capsular
remnant or rim of the capsular bag is ruptured, that is cut or
torn. A ruptured capsular rim may be produced in different ways.
For example, improper performance of a continous tear circular
capsulorhexis may result in accidental cutting or tearing of the
anterior rim. A beer can or can opener capsulorhexis, on the other
hand, produces an anterior capsular rim which is not intact and has
an inner scalloped edge having stress-inducing regions that render
the rim very prone to tearing during surgery or subsequent
fibrosis. An envelope capsulorhexis inherently produces an anterior
capsular remnant which is ruptured and not intact.
A ruptured anterior capsular remnant or rim may preclude
utilization of a simple plate haptic lens of the invention for the
following reasons. A ruptured rim may not firmly retain the lens
haptics in the sulcus of the capsular bag during fibrosis, thereby
rendering the lens prone to decentration and/or posterior or
anterior dislocation. A ruptured capsular rim may be incapable of
assuming the taut trampoline-like condition of a non-ruptured rim.
If so, a ruptured capsular rim is incapable of effecting full
posterior deflection of a plate haptic lens to a distant viewing
position against the posterior capsule during and after fibrosis.
In fact, a ruptured capsular rim may permit anterior deflection of
the lens. In either case, since the power of the lens is selected
for each individual patient and is dependent upon their spectacle
power, and since good vision without glasses requires the lens
optic to be at precisely the correct distance from the retina, a
simple plate haptic lens of the invention may not be acceptable for
use with a ruptured anterior capsular remnant or rim.
The accommodating plate haptic spring lenses of the invention are
designed for use when the anterior capsular remnant or rim of the
capsular bag is ruptured. These plate haptic spring lenses are
similar to the simple plate haptic lenses but have resilient
springs, such as spring loops, at the ends of the plate haptics.
When a plate haptic spring lens is implanted in a capsular bag, the
haptic springs press outward against the wall of the capsular bag
sulcus to fixate the lens in the bag during fibrosis. Fibrosis
occurs about the springs in such a way as to effect fusion of the
ruptured anterior remnant to the posterior capsule, firm fixation
of the the springs and hence the haptics in the bag, and posterior
deflection of the lenses against the elastic posterior capsule
during fibrosis. Brain-induced constriction and relaxation of the
ciliary muscle after fibrosis with a ruptured capsular rim effects
accommodation of the plate haptic spring lens in much the same way
as occurs with the simple plate haptic lens and an intact
non-ruptured capsular rim.
While the plate haptic spring lenses of the invention are designed
for use with a ruptured anterior capsular remnant or rim, these
lenses can also be utilized with an intact rim. A plate haptic
spring lens also compensates for improper lens placement in the eye
with one end of the lens situated in the capsular bag and the other
end of the lens situated in the ciliary sulcus of the eye. In this
regard, an advantage of the plate haptic spring lenses of the
invention over the simple plate haptic lenses resides in the fact
that the spring lenses eliminate the need to have on hand in the
operating room both a simple plate haptic lens for use with an
intact capsular rim and a plate haptic spring lens as a substitute
for the plate haptic lens in the event the rim is ruptured during
surgery.
Another advantage of the plate haptic spring lenses over the simple
plate haptic lenses of the invention resides in the fact that the
haptic spring lenses permit an optic of larger diameter than those
of simple plate haptic lenses whose optic diameters will normally
be restricted to the range of 4-7 mm. Thus, the haptic spring
lenses rely on the haptic springs rather than the capsular remnant
or rim to retain the lenses in position during fibrosis. As a
consequence, these lenses may be used with a capsular remnant or
rim of reduced radial width or a capsular rim which is slit or
torn, both of which rim types provide a capsulotomy of larger
effective size than those possible with a simple plate haptic lens.
A larger capsulotomy, in turn, permits a larger optic diameter
which offers certain opthalmological benefits. According to one
aspect of this invention, such a large capsulotomy is provided
after fibrosis is complete by using a laser to slit the anterior
capsular rim radially or cut the rim circumferentially to enlarge
the capsulotomy.
A further aspect of the invention concerns a novel method of
utilizing an accommodating lens of the invention to provide
accommodation in a human eye whose natural lens matrix has been
removed from the lens capsule by a procedure involving capulorhexis
of the anterior capsule of the natural lens. The method may be
utilized to replace a natural lens from which a cataract has been
removed and to correct a refractive error in the eye of a patient
who previously wore glasses in order to enable the patient to see
well without glasses. For example, the invention can can be
utilized to correct refractive errors and restore accommodation to
persons in their mid-40's who require reading glasses or bifocals
for near vision by replacing the clear non-cataractous crystalline
lens matrix of their eyes with an accomodating intraocular lens
according to the invention. According to the method of utilizing a
plate haptic spring lens of the invention, the anterior capsular
remnant or rim of the capsular bag is slit radially or cut to
enlarge the anterior capsulotomy after capsulorhexis is complete to
permit the use of a lens with a relatively large diameter optic
larger than 6 or 7 mm.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a section through a human eye from which the natural lens
matrix has been removed by a surgical procedure involving
capsulorhexis of the natural lens, and illustrating an
accommodating simple plate haptic accommodating lens according to
this invention implanted within the capsular bag of the eye;
FIG. 1A is a section through a normal human eye;
FIG. 2 is an anterior side view of the intraocular lens of FIG.
1;
FIG. 3 is a section taken on line 3--3 in FIG. 2;
FIG. 4 is a section taken on line 4--4 in FIG. 1;
FIGS. 5-8 illustrate the manner in which the intraocular lens of
FIGS. 1-4 is utilized in the eye of FIG. 1 to provide
accommodation;
FIGS. 9-12 are sections, similar to FIG. 3, through modified
accommodating intraocular lenses according to the invention having
alternative optical shapes;
FIG. 13 is a section similar to FIG. 3 through a modified
accommodating intraocular lens according to the invention
illustrating the lens in its normal unstressed configuration;
FIG. 14 is a section similar to FIG. 13, illustrating the lens in
its distant vision position;
FIG. 15 is a section through a modified accommodating intraocular
lens according to the invention having an anteriorly displaced
optic;
FIG. 16 is an anterior side view of a modified accommodating
intraocular lens according to the invention having integral
fixation means for fixing the lens in the capsular bag of the
eye;
FIG. 17 is a section taken on line 17--17 in FIG. 16;
FIGS. 18-21 are anterior side views of modified accommodating
intraocular lenses according to the invention having alternative
integral fixation means for fixing the lenses in the capsular bag
of the eye;
FIG. 22 is an anterior side view of a modified accommodating
intraocular lens according to the invention having springs for
aiding accommodation;
FIG. 23 illustrates the lens of FIG. 22 implanted within the
capsular bag of a human eye like that in FIG. 1, and showing the
lens in the position which the lens occupies immediately after
surgery as well as after a certain degree of accommodation;
FIG. 24 is a view similar to FIG. 23 showing the lens in its
posterior distant vision position;
FIGS. 25-30 are anterior side views of modified accommodating
intraocular lenses according to the invention having separate
fixation means for fixing the lenses in the capsular bag of a human
eye like that in FIG. 1;
FIGS. 31-34 illustrate modified accommodating intraocular lenses
according to the invention having integral fixation means;
FIGS. 35-37 illustrate the capsulotomy produced by a continuous
tear circular capsulotomy, a beer can capsulotomy, and an envelope
capsulotomy, respectively;
FIG. 38 is an anterior face view of a plate haptic spring lens
according to the invention;
FIG. 39 is a view similar to FIG. 4 showing the plate haptic spring
lens of FIG. 38 implanted within the eye;
FIG. 40 is an enlarged section taken on line 40--40 in FIG. 39;
FIGS. 41 and 42 illustrate two ways of enlarging the capsulotomy of
a capsular bag after completion of fibrosis to allow anterior
movement of a relatively large lens optic;
FIG. 43 is an anterior side view of a modified plate haptic lens
according to the invention; and
FIGS. 44-46 illustrate modified plate haptic spring lenses
according to the invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Turning now to these drawings and first to FIGS. 1 and 1A, there is
illustrated a human eye 10 from which the natural crystalline lens
matrix was previously removed by a surgical procedure involving
continous tear circular capsulorhexis of the natural lens L of the
eye. The natural lens comprises a lens capsule having elastic
anterior and posterior walls A and P, respectively, which are
referred to by ophthalmologists and herein as anterior and
posterior capsules, respectively. Within the lens capsule is a
normally optically clear crystalline lens matrix M. In many
individuals, this lens matrix becomes cloudy with advancing age and
froms what is called a cataract. It is now common practice to
restore a cataract patient's vision by removing the cataract from
the natural lens and replacing the lens matrix by an artificial
intraocular lens.
As mentioned earlier, continous tear circular capsulorhexis
involves tearing the anterior capsule A along a generally circular
tear line in such a way as to form a relatively smooth-edged
circular opening or capsulotomy in the center of the anterior
capsule. The cataract is removed from the natural lens capsule
through this capsulotomy. After completion of this surgical
procedure, the eye includes an optically clear anterior cornea 12,
an opaque sclera 14 on the inner side of which is the retina 16 of
the eye, an iris 18, a capsular bag 20 behind the iris, and a
vitreous cavity 21 behind the capsular bag filled with the gel-like
vitreous humor. The capsular bag 20 is the structure of the natural
lens of the eye which remains intact within the eye after the
continous tear circular tear capsulorhexis has been performed and
the natural lens matrix has been removed from on the natural
lens.
The capsular bag 20 includes an annular anterior capsular remnant
or rim 22 and an elastic posterior capsule 24 which are joined
along the perimeter of the bag to form an annular crevice-like
capsular bag sulcus 25 between rim and posterior capsule. The
capsular rim 22 is the remnant of the anterior capsule of the
natural lens which remains after capsulorhexis has been performed
on the natural lens. This rim circumferentially surrounds a
central, generally round anterior opening 26 (capsulotomy) in the
capsular bag through which the natural lens matrix was previously
removed from the natural lens. The capsular bag 20 is secured about
its perimeter to the ciliary muscle of the eye by zonules 30.
Natural accommodation in a normal human eye having a normal human
crystalline lens involves automatic contraction or constriction and
relaxation of the ciliary muscle of the eye by the brain in
response to looking at objects at different distances. Ciliary
muscle relaxation, which is the normal state of the muscle, shapes
the human crystalline lens for distant vision. Ciliary muscle
contraction shapes the human crystalline lens for near vision. The
brain-induced change from distant vision to near vision is referred
to as accommodation.
Implanted within the capsular bag 20 of the eye 10 is an
accommodating intraocular lens 32 according to this invention which
replaces and performs the accommodation function of the removed
human crystalline lens. Lens 32 is referred to in places as a
simple plate haptic lens to distinguish it from the lager described
plate haptic spring lens of the invention. As mentioned earlier and
will become readily understood as the description proceeds, the
accommodating intraocular lens may be utilized to replace either a
natural lens which is virtually totally defective, such as a
cataractous natural lens, or a natural lens that provides
satisfactory vision at one distance without the wearing of glasses
but provides satisfactory vision at another distance only when
glasses are worn. For example, the accommodating intraocular lens
of the invention can be utilized to correct refractive errors and
restore accommodation for persons in their mid-40's who require
reading glasses or bifocals for near vision.
Intraocular lens 32 comprises a body 33 which may be formed of
relatively hard material, relatively soft flexible semi-rigid
material, or a combination of both hard and soft materials.
Examples of relatively hard materials which are suitable for the
lens body are methyl methacrylate, polysulfones, and other
relatively hard biologically inert optical materials. Examples of
suitable relatively soft materials for the lens body are silicone,
hydrogels, thermolabile materials, and other flexible semi-rigid
biologically inert optical materials.
The lens body 33 has a generally rectangular shape and includes a
central optical zone or optic 34 and plate haptics 36 extending
from diametrically opposite edges of the optic. The haptics have
inner ends joined to the optic and opposite outer free ends. The
haptics 36 are movable anteriorly and posteriorly relative to the
optic 34, that is to say the outer ends of the haptics are movable
anteriorly and posteriorly relative to the optic. The particular
lens embodiment illustrated is constructed of a resilient
semi-rigid material and has flexible hinges 38 which join the inner
ends of the haptics to the optic. The haptics are relatively rigid
and are flexible about the hinges anteriorly and posteriorly
relative to the optic. These hinges are formed by grooves 40 which
enter the anterior side of the lens body and extend along the inner
ends of the haptics. The haptics 36 are flexible about the hinges
38 in the anterior and posterior directions of the optic. The lens
has a relatively flat unstressed configuration, illustrated in
FIGS. 2 and 3, wherein the haptics 36 and their hinges 38 are
disposed in a common plane transverse to the optic axis of the
optic 34. Deformation of the lens from this unstressed
configuration by anterior or posterior deflection of the haptics
about their hinges 38 creates in the hinges elastic strain energy
forces which bias the lens to its unstressed configuration. If the
lens is constructed of a relatively hard optic material, it may be
necessary to replace the flexible hinges 38 by pivotal hinges of
some kind. In a later described lens embodiment of the invention,
the haptic hinges are eliminated, and the haptics are made flexible
throughout their length.
The accommodating intraocular lens 32 is implanted within the
capsular bag 20 of the eye 10 in the position shown in FIGS. 1 and
5. When implanting the lens in the bag, the ciliary muscle 28 of
the eye is maintained in a relaxed state in which the muscle
stretches the capsular bag 20 to its maximum diameter. The lens is
inserted into the bag through the anterior capsular capsulotomy 26
and placed in the position shown in FIGS. 1 and 4. In this
position, the lens optic 34 is aligned on the axis of the eye with
the capsolotomy, the posterior side of the lens faces the elastic
posterior capsule 24 of the bag, and the outer ends of the lens
haptics 36 are situated within the sulcus 25 at the radially outer
perimeter of the bag. The overall length of the lens substantially
equals the inner diameter (10-11 mm) of the stretched capsular bag
so that the lens fits snugly within the stretched capsular bag, as
shown. This prevents decentration of the lens and thereby permits
the optic 34 to be smaller such that it can move forward inside the
capsular rim during the later described accommodation.
During a post-operative healing period on the order of two to three
weeks following surgical implantation of the lens 32 in the
capsular bag 20, epithelial cells under the anterior capsular rim
22 of the bag cause fusion of the rim to the posterior capsule 24
by fibrosis. This fibrosis occurs around the lens haptics 36 in
such a way that the haptics are "shrink-wrapped" by the capsular
bag 20, and the haptics form pockets 42 in the fibrosed material F
(FIGS. 4 and 6-8). These pockets position and center the lens in
the eye. In order to insure proper formation of the haptic pockets
42, sufficient time must be allowed for fibrosis to occur to
completion without flexing of the lens haptics 36 by ciliary muscle
action. One way of accomplishing this is to have the patient
periodically administer cycloplegic drops, such as Atropine, into
his eye during the post-operative fibrosis period. These drops
maintain the ciliary muscle 28 in its relaxed state. In this
relaxed state, the capsular bag 20 is stretched to its maximum
diameter, and the anterior capsular rim 22 is stretched to a taut
trampoline-like condition or position. The rim fibroses from this
taut condition.
The capsular rim 22 shrinks during fibrosis and thereby shrinks the
capsular bag 20 slightly in its radial direction. This shrinkage
combined with shrink wrapping of the lens haptics 36 produces
opposing endwise compression forces on the ends of the haptics
which tend to buckle or flex the lens at its hinges 38 and thereby
move the lens optic 34 along the axis of the eye. Unless
restrained, this flexing of the lens might occur either forwardly
or rearwardly. The taut anterior capsular rim 22 pushes rearwardly
against and thereby prevents forward flexing of the lens.
Accordingly, endwise compression of the lens during fibrosis aided
by the rearward thrust of the taut capsular rim against the lens
haptics 36 causes rearward flexing of the lens from its initial
position of FIGS. 1 and 5 to is position of FIG. 6. The lens
haptics 36 are made sufficiently rigid that they will not be bent
or bowed by the forces of fibrosis. At the conclusion of fibrosis,
the lens occupies its posterior position of FIG. 6 wherein the lens
presses rearwardly against the elastic posterior capsule 24 and
stretches this capsule rearwardly. The posterior capsule then
exerts a forward elastic bias force on the lens. This posterior
position of the lens is its distant vision position.
Another way of preventing ciliary muscle induced flexing of the
lens 32 during fibrosis is to place sutures within the hinge
grooves 40. Removal of these sutures after completion of fibrosis
may be accomplished by using sutures that are either absorbable in
the fluid within the eye or by using sutures made of a material,
such as nylon, which can be removed by a laser.
Natural accommodation in a normal human eye involves shaping of the
natural crystalline lens by automatic contraction and relaxation of
the ciliary muscle of the eye by the brain to focus the eye at
different distances. Ciliary muscle relaxation shapes the natural
lens for distant vision. Ciliary muscle contraction shapes the
natural lens for near vision.
The accommodating intraocular lens 32 is uniquely constructed to
utilize this same ciliary muscle action, the fibrosed capsular rim
22, the elastic posterior capsule 24, and the vitreous pressure
within the vitreous cavity 21 to effect accommodation movement of
the lens optic 34 along the optic axis of the eye between its
distant vision position of FIG. 6 to its near vision position of
FIG. 8. Thus, when looking at a distant scene, the brain relaxes
the ciliary muscles 28. Relaxation of the ciliary muscle stretches
the capsular bag 20 to its maximum diameter and its fibrosed
anterior rim 22 to the taut trampoline-like condition or position
discussed above. The taut rim deflects the lens rearwardly to its
posterior distant vision position of FIG. 6 in which the elastic
posterior capsule 24 is stretched rearwardly by the lens and
thereby exerts a forward bias force on the lens. When looking at a
near scene, such as a book when reading, the brain constricts or
contracts the ciliary muscle. This ciliary muscle contraction has
the three-fold effect of increasing the vitreous cavity pressure,
relaxing the capsular bag 20 and particularly its fibrosed capsular
rim 22, and exerting opposing endwise compression forces on the
ends of the lens haptics 36 with resultant endwise compression of
the lens. Relaxation of the capsular rim permits the rim to flea
forwardly and thereby enables the combined forward bias force
exerted on the lens by the rearwardly stretched posterior capsule
and the increased vitreous cavity pressure to push the lens
forwardly in an initial accommodation movement from the position of
FIG. 6 to the intermediate accommodation position of FIG. 7.
In this intermediate accommodation position, the lens is
substantially flat, and the ends of the lens haptics and their
hinges 38 are disposed substantially in a common plane normal to
the axis of the eye. During the initial accommodation, the lens
arches rearwardly so that endwise compression of the lens by
ciliary muscle contraction produces a rearward buckling force on
the lens which resists the initial accommodation. However, the
increased vitreous cavity pressure and the forward bias force of
the stretched posterior capsule are sufficient to overcome this
opposing rearward buckling force and effect forward accommodation
movement of the lens to and at least just slightly beyond the
intermediate position of FIG. 7. At this point, endwise compression
of the lens by the contracted ciliary muscle produces a forward
buckling force on the lens which effects final accommodation of the
lens beyond the intermediate position of FIG. 7 to the near vision
position of FIG. 8. Subsequent brain-induced relaxation of the
ciliary muscle 28 in resonse to looking at a distant scene reduces
the vitreous cavity pressure, stretches the capsular bag 20 to its
maximum diameter, and restores the anterior capsular rim 22 to its
taut trampoline-like condition to effect return of the lens to its
distant viewing position of FIG. 6. During accommodation, the lens
optic 34 moves along the axis of the eye toward and away from the
retina 16. The power of the optic is selected by the brain to
sharply focus incoming light rays on the retina throughout the
range of this accommodation movement.
The lens haptics 36 flex at their hinges 38 with respect to the
lens optic 34 during accommodation. Any elastic strain energy
forces developed in the hinges during this flexing produces
additional anterior and/or posterior forces on the lens. For
example, assume that the lens is relatively flat, i.e. if the lens
haptics 36 lie in a common plane as shown in FIG. 1, in the normal
unstressed state of the lens. In this case, posterior deflection of
the lens from its position of FIG. 1 to its distant vision position
of FIG. 6 creates elastic strain energy forces in the hinges 38
which urge the lens forwardly back to its unstressed position of
FIG. 1 and thus aid the above discussed initial accommodation of
the lens in response to contraction of the ciliary muscle. Final
accommodation flexing of the lens from its intermediate position of
FIG. 7 to its near vision position of FIG. 8 creates elastic strain
energy forces in the hinges 38 which urge the lens rearwardly
toward its unstressed position and thus aid initial return of the
lens from its near vision position to its distant vision position
in response to relaxation of the ciliary muscle. The lens may be
designed to assume some other normal unstressed position, of
course, in which case any elastic strain energy forces created in
the lens during flexing of the haptics will aid, resist, or both
aid and resist accommodation of the lens to its near vision
position and return of the lens to its distant vision position
depending upon the unstressed position of the lens.
During accommodation the lens haptics 36 slide endwise in their
fibrosed tissue pockets 42. As shown best in FIGS. 2 and 3, the
haptics are tapered endwise in width and thickness to enable the
haptics to move freely in the pockets. The lens optic 34 moves
toward and away from the anterior capsular rim 22. The diameter of
the optic is made as large as possible to maximize its optical
imaging efficiency. The optic is preferably but not necessarily
made smaller than the diameter of the capsulotomy 26 to permit
accommodation movement of the optic into and from the capsulotomy
without interference by the capsular rim 22 in order to maximize
the accommodation range. The actual lens dimensions are determined
by each patient's ocular dimensions. The dimensions of a simple
plate haptic intraocular lens according to the invention will
generally fall within the following ranges:
______________________________________ Optic diameter: 3.0 mm-7.0
mm Overall lens length: 9.0 mm-11.5 mm Haptic thickness: 0.25
mm-0.35 mm ______________________________________
Refer now to FIGS. 9-15 illustrating several possible alternative
shapes of the accommodating intraocular lens. The modified lens 50
illustrated in FIG. 9 is identical to lens 32 of FIGS. 1-8 except
that the haptic hinges 38 of lens 32 are eliminated in the lens 50,
and the haptics 52 of the lens 50 are flexible throughout their
length, as illustrated by the broken lines in FIG. 9. The modified
lens 54 in FIG. 10 has an anteriorly arched unstressed shape and
includes a bi-convex optic 56, flexible hinges 58, and anteriorly
vaulted haptics 60 with convex anterior surfaces 62. The convex
anterior face 64 of the optic 56 and the convex anterior haptic
surfaces 62 are rounded to a common radius. The modified
intraocular lens 66 in FIG. 11 is relatively flat and includes an
optic 68 having a planar Fresnel anterior face 70 and a convex
posterior face 72, haptics 73, and flexible haptic hinges 74. The
modified lens 76 in FIG. 12 has a posteriorly arched unstressed
shape and includes an optic 78 having a planar anterior face 80 and
a convex posterior face 82, haptics 84 having convex posterior
surfaces 86 and haptic hinges 88. The posterior face 82 of the
optic 78 and the posterior surfaces 86 of the haptics 84 are
rounded to a common radius. The modified lens 90 illustrated in
FIGS. 13 and 14 includes an optic 92 and flexible haptics 94 and
has an unstressed near vision configuration shown in FIG. 13. The
haptics flex to permit posterior deflection of the lens to its
distant vision configuration of FIG. 14. The optic 92 is
posteriorly offset relative to the inner ends of the haptics to
permit greater anterior displacement of the optic during
accommodation without contacting the anterior capsular rim 22 of
the capsular bag 20. The modified intraocular lens 100 of FIG. 15
includes haptics 102 and an optic 104 which is offset anteriorly
relative to the inner ends of the haptics. The haptics are joined
to diametrically opposite sides of the optic by flexible hinges
106.
The modified intraocular lenses of FIGS. 9-15 are implanted within
the capsular bag 20 of the eye 10 and utilize the posterior bias of
the fibrosed capsular rim 22, the posterior capsule 24, changes in
vitreous cavity pressure, and the patient's ciliary muscle action
to effect accommodation in the same manner as described in
connection with the intraocular lens 32 of FIGS. 1-8. In the case
of the lens 100 in FIG. 15, the outer ends of its haptics 102 are
implanted within the capsular bag 20 in essentially the same way as
the haptics of lens 32 so that fibrosis of the rim 22 occurs about
the haptics in the same manner as described in connection with
FIGS. 1-8. The anteriorly offset optic 104 of the lens 100, on the
other hand, protrudes through the anterior opening 26 in the
capsular bag 20 and is situated anteriorly of the rim and between
the rim and the iris 18 of the eye. There is sufficient space
between the rim and the iris to accommodate the optic of a properly
sized lens without the optic contacting the iris.
FIGS. 16-20 illustrate modified accommodating intraocular lenses
according to the invention having means for fixating or anchoring
the lens haptics in the capsular bag 20 to prevent the lenses from
entering the vitreous cavity 21 of the eye in the event that the
posterior capsule 24 becomes torn or a posterior capsulotomy must
be performed on the posterior capsule because it becomes hazy.
Except as noted below, the modified intraocular lenses of FIGS.
16-20 are identical to the lens 32 of FIGS. 1-8 and are implanted
in the capsular bag 20 of the eye 10 in the same manner as
described in connection with FIGS. 1-8. The intraocular lens 110 of
FIGS. 16 and 17 is identical to lens 32 except that the outer ends
of the lens haptics 112 have raised shoulders 114. Fibrosis of the
capsular rim 22 around the haptics 112 and their shoulders 114
anchors or fixates the lens 110 in the capsular bag 20. The
intraocular lens 116 of FIG. 18 is identical to lens 32 except that
flexible stalk-like knobs 118 extend diagonally from the outer ends
of the lens plate haptics 120. The distance between the outer ends
of the diametrically opposed knobs 118 is slightly larger than the
distance between the outer ends of the lens haptics and slightly
larger than the diameter of the capsular bag 20. The knobs are set
wider than the width of the lens body. These two features help to
center the intraocular lens within the capsular bag so that the
lens optic is centered immediately behind the circular capsulotomy
26 in the bag. Fibrosis of the capsular rim 22 around the haptics
120 and their knobs 118 fixes the lens 116 in the capsular bag 20.
The intraocular lens 122 of FIG. 19 is identical to lens 32 except
that the outer ends of the lens haptics 124 have openings 126.
Fibrosis of the capsular rim 22 occurs around the haptics 124 and
through their openings 126 to fixate the lens 122 in the capsular
bag 20. The intraocular lens 128 of FIG. 20 is similar to the lens
122 in that the lens 128 has openings 130 in the outer ends of its
haptics 132 through which fibrosis of the capsular rim 22 occurs to
fixate the lens in the capsular bag 20. Unlike the lens 122,
however, the haptic openings 130 are bounded along the outer ends
of the haptics by spring loops 134. The overall length of the lens
128, measured between the centers of the spring loops 134 is made
slightly greater than the maximum diameter of the capsular bag. The
spring loops 134 press against and are deformed inwardly slightly
by the outer circumference of the capsular bag to center the lens
in the eye during fibrosis.
The modified intraocular lens 140 of FIG. 21 is identical to the
lens 32 of FIGS. 1-8 except that the lens 140 has centration
nipples 142 projecting endwise from the outer ends of the lens
haptics 144 to compensate for slight differences, from one patient
to another, in the diameter of the human capsular bag 20. Thus, the
diameter of the capsular bag varies from about 11 mm in high myopes
to about 9.5 mm in high hyperopes. The centration nipples 142
prevent differences in the degree of flexing of the haptics 144 in
capsular bags of different diameters. For example, in a hyperopic
eye with a small capsular bag, the lens haptics would flex more
with marked posterior vaulting of the lens by the fibrosed capsular
rim compared to the minimal vaulting of the haptics which would
occur in high myopes with relatively large capsular bags. The
nipples indent themselves into the outer circumference of the
capsular bag to compensate for such differing bag diameters and
thereby center the lens in the bag.
The modified intraocular lens 150 illustrated in FIGS. 22-24
comprises a lens body 152 proper identical to that of FIGS. 1-8 and
springs 154 in the form of U-shaped hoops constructed of
biologically inert spring material. The ends of these springs are
fixed to the anterior sides of the lens haptics 156 adjacent the
haptic hinges 158 in such a way that the arched ends of the springs
extend a small distance beyond the outer ends of the haptics. The
springs are stressed to normally lie relatively close to the
anterior sides of the haptics. The lens body 152 is implanted
within the capsular bag 20 of the eye 10 in the same way as
described in connection with the lens 32 of FIGS. 1-8, and with the
outer arched ends of the lens springs 154 lodged within the sulcus
19 of the eye between the iris 18 and the cornea 12. When the lens
is in the position of FIG. 23 which it occupies immediately after
surgery as well as after some degree of accommodation, the springs
154 lie relatively close to the anterior sides of the lens haptics
156. During posterior displacement of the lens to its distant
vision position of FIG. 24 by the posterior bias of the fibrosed
capsular rim 22, the springs are deflected anteriorly away from the
lens haptics, as shown, thereby creating in the springs elastic
strain energy forces which aid the stretched posterior capsule 24
and vitreous cavity pressure in displacing the lens anteriorly
during accommodation in response to contraction of the ciliary
muscle 28.
FIGS. 25-32 illustrate modified intraocular lenses according to the
invention having a lens body and separate lens fixation elements
for positioning the lenses in the capsular bag 20. Fibrosis of the
capsular rim 22 occurs around these fixation elements in a manner
which securely fixes the elements within the bag. In some figures,
the lens body is separable from the fixation elements to permit
removal of the lens from and replacement of the lens in its
original position in the eye. In other figures, the lens body and
fixation elements are secured against separation to prevent
entrance of the lens body into the vitreous chamber in the event a
tear develops in the posterior capsule 24 of the bag or a posterior
capsulotomy is performed in the capsule.
The modified lens 160 of FIG. 25 includes a lens body 162 which is
identical, except as noted below, to that of lens 32 in FIGS. 1-8
and separate fixation elements 164 at the outer ends of the lens
haptics 166. The fixation elements and haptics are interengaged in
such a way that the elements and haptics are capable of relative
movement lengthwise of the haptics when the haptics flex during
accommodation of the lens. The fixation elements 164 in FIG. 25 are
generally U-shaped loops of biologically inert material having legs
168 which slide within longitudinal sockets 170 entering the outer
ends of the haptics 166. The haptics 166 are somewhat shorter in
length than those of the lens 32, and the overall length of the
lens, measured between the outer arched ends of the fixation loops
164, when their legs 168 abut the bottoms of their sockets 170, is
less than the maximum diameter of the capsular bag 20 when the
ciliary muscle 28 is relaxed and greater than the diameter of the
bag when the ciliary muscle is fully contracted for accommodation.
The lens 160 is implanted within the capsular bag 20 of the eye 10
with the fixation loops 164 and the outer ends of the haptics 166
disposed between the anterior rim 22 and posterior capsule 24 of
the capsular bag 20. The outer arched ends of the loops are
situated at the outer circumference of the bag.
Fibrosis of the capsular rim 22 occurs around the outer ends of the
lens haptics 166 and the exposed outer ends of the fixation loops
164 and through the spaces between the haptics and the loops in
such a way that the loops are firmly fixed in the capsular bag, and
the haptics form pockets 42 in the fibrose tissue F. The posterior
bias of the fibrosed capsular rim 22 urges the lens posteriorly to
its distant vision position when the ciliary muscle 28 is relaxed,
thereby stretching the posterior capsule 24 rearwardly in the same
manner as explained in connection with FIGS. 1-8. When the ciliary
muscle contracts during accommodation, the vitreous cavity pressure
increases and the capsular rim 22 relaxes, thereby permitting the
stretched posterior capsule and the vitreous cavity pressure to
push the lens body 162 forwardly toward its near vision position,
again in the same manner as explained in connection with FIGS. 1-8.
Contraction of the capsular bag in response to contraction of the
ciliary muscle during accommodation displacement exerts inward
forces on the fixation loops 164. These inward forces urge the
loops inwardly in their haptic sockets 170 until the loops abut the
bottoms of the sockets. The inward forces exerted on the loops then
produce an anterior buckling moment on the lens body 162 which aids
accommodation of the lens by the posterior capsule. During this
accommodation, the lens haptics 166 flex posteriorly relative to
the lens optic 172 and slide inwardly in their fibrose pockets 42
and along the legs 168 of the fixation loops 164, the movement
being aided by hinges 38.
The fixation loops have holes 174 in their outer arched ends
through which a suture 176 may be passed and tied to retain the
loops and lens body in assembled relation during implantation of
the lens in the capsular bag. This suture is removed at the
conclusion of the surgery. Holes 174 may also be utilized to
position the lens in the capsular bag during surgery. The lens
haptics 166 are separable from and reengageable with the fixation
loops 164. This permits the lens body 162 to be removed from the
eye any time after surgery for correction or replacement of the
lens optic 172 and then replaced in its original position in the
eye.
The modified intraocular lens 180 of FIG. 26 is similar to that of
FIG. 25 except for the following differences. First, the haptics
182 of lens 180 are substantially the same length as the haptics of
lens 32 and have cutouts 184 in their outer ends. The legs 188 of
the fixation loops 186 slide in sockets 190 which enter the bottom
edges of the cutouts 184. When the lens is implanted within the
capsular bag 20, the tongue-like haptic portions at opposite sides
of the haptic cutouts 184 and the outer arched ends of the fixation
loops 186 are situated within the outer circumference of the bag.
As with the lens of FIG. 25, fibrosis of the capsular rim 22 occurs
around the haptics 182 and fixation loops 186 and through the
spaces between the haptics and loops so as to firmly fix the loops
in the capsular bag and form pockets within which the haptics slide
when they flex during accommodation of the lens. Secondly, the legs
188 of the fixation loops 186 and their sockets 190 in the lens
haptics 182 are tapered to facilitate free relative movement of the
loops and haptics when the haptics flex during accommodation.
Thirdly, the fixation loops have fixation nipples 192 at their
outer arched ends which indent into the outer circumference of the
capsular bag 20 to retain the lens against movement relative to the
bag during fibrosis.
FIG. 27 illustrates a modified intraocular lens 196 like the lens
180 illustrated in FIG. 26 except that the legs 198 of the fixation
loops 200 and the haptic sockets 202 which receive these legs have
coacting shoulders 204, 206. These shoulders permit limited
relative movement of the lens body 208 and loops when the haptics
210 flex during lens accommodation, but secure the lens body and
loops against complete separation so as to prevent the lens body
from entering the vitreous chamber 21 if a tear occurs or a
capsulotomy is performed in, the posterior capsule 24. Another
difference between the lens 196 and the lens 180 resides in the
fact that the hinges 212 connecting the inner ends of the haptics
210 to the lens optic 214 extend across only an intermediate
portion of the haptic width. The remaining lateral portions of the
inner haptic ends beyond the ends of the hinges are separated from
the optic by arcuate slots 216 centered on the axis of the optic.
These separations of the haptics from the optic permit the optic to
move freely into and from the anterior opening or capsulotomy 26 in
the capsular bag 20 without interference with the capsular rim 22
during lens accommodation. The generally triangular haptic portions
adjacent the slots 216 prevent the rim 22 of the capsular bag 20
from fibrosing between the lens optic 214 and the inner ends of the
lens haptics 210 and thereby restricting endwise movement of the
haptics in their fibrosed pockets 42.
The modified lens 220 of FIG. 28 includes a lens body 222 and
separate fixation elements 224 at the outer ends of the lens
haptics 226. The inner ends of the haptics are convexly curved and
disposed in generally tangential relation to diametrically opposite
sides of the lens optic 228 so as to provide relatively large
clearance spaces 230 between the optic and the inner haptic ends.
The haptics and optic are joined along their tangential portions by
flexible hinges 232. The fixation elements 224 are generally
cruciform shaped pins having inner journals 234 which slide and
rotate within bearing bores 236 entering the bottom edges of
cutouts 238 in the outer ends of the haptics 226. These fixation
pins have holes 240 between their ends, outer cross arms 242, and
nipples 244 at their outer ends. The length of the lens 220
measured between the outer ends of its haptics 226 and fixation
pins 224 approximates the maximum inner diameter of the capsular
bag 20 when the ciliary muscle is relaxed. The fixation pin
journals 234 and their bores 236 have coacting shoulders 246, 248
which permit limited relative movement of the lens body and
fixation pins when the haptics flex during accommodation but secure
the body and fixation pins against complete separation, for the
same reasons as explained above in connection with FIG. 27. If
desired, the shoulders 246, 248 may be eliminated to permit
separation of the fixation pins and lens body for the same reasons
as explained in connection with FIG. 26. If the shoulders are
eliminated, a removable suture may be threaded through the fixation
pin holes 240 and tied to hold the fixation pins and lens body in
assembled relation during implantation of the lens, as explained in
connection with FIG. 25. The holes may also be used to position the
lens in the capsular bag during implantation of the lens.
When the lens 220 is implanted within the capsular bag 20 of the
eye 10, the outer ends of the lens haptics 226 and the fixation
pins 224 are disposed between the capsular rim 22 and posterior
capsule 24 of the bag in much the same way as described in
connection with FIGS. 25-27. The nipples 244 indent the outer
circumference of the bag to fix the lens against rotation
circumferentially around the bag and center the lens in the eye
during fibrosis of the rim 22. Fibrosis of the capsular rim occurs
about the outer ends of the haptics and the fixation pins to firmly
fix the pins in the bag and form pockets in the fibrosed tissue
receiving the haptics. The lens body 222 is urged posteriorly to
its distant vision position by the posterior bias of the capsular
rim 22 when the ciliary muscle 28 relaxes and anteriorly toward its
near vision position during accommodation by the stretched
posterior capsule 24 and increase in vitreous cavity pressure when
the ciliary muscle contracts, all in essentially the same way as
explained earlier in connection with FIGS. 25-27. During anterior
accommodation of the lens, contraction of the capsular bag 20 in
response to contraction of the ciliary muscle exerts inward forces
on the outer ends of the haptics 226 which produce an anterior
buckling moment on the lens body 222 that aids lens accommodation
by the posterior capsule. The cross arms 242 of the fixation pins
224 are enveloped by the fibrosed tissue F during fibrosis of the
rim 22 to provide pivots about which the pins can rotate during
buckling of the lens body in the course of lens accommodation. The
spaces 230 between the inner ends of the haptics 226 and the optic
228 accommodate movement of the optic into and from the opening 26
in the capsular bag without interference with the surrounding
capsular rim 22.
The modified intraocular lenses 260, 262 in FIGS. 29 and 30 are
identical to the lenses 180, 196, respectively, in FIGS. 26 and 27
except that the fixation loops of the latter lenses are replaced in
FIGS. 29 and 30, by fixation pins 264, 266 like those in FIG.
28.
The modified intraocular lenses 270, 272 in FIGS. 31 and 32 are
identical to the lens 32 of FIGS. 1-8 except that lens 270 has
lateral spring arms 274 which extend from the haptic hinges 276 and
lens 272 has lateral spring arms 278 which extend from the edges of
the lens haptics 280. The arms 274, 278 extend laterally from and
longitudinally toward the outer ends of the lens haptics in such a
way that in their normal unstressed positions, the arms are
disposed at acute angles relative to the longitudinal axes of the
lenses. The arms are sized in length so that when the lenses are
implanted within the capsular bag 20 of the eye, the outer ends of
the arms press against the outer circumference of the bag and are
thereby curled or compressed to the positions illustrated in broken
lines. The curl or compression in the arms decreases when the
capsular bag expands in response to relaxation of the ciliary
muscle during distant vision accommodation of the lens and
increases when bag contracts in response to contraction of the
ciliary muscle during near vision accommodation of the lens.
Engagement of the arms with the capsular bag circumference acts to
center the lenses in the bag in a position wherein the lens optics
282, 284 are coaxially aligned with the anterior bag opening or
capsulotomy. Fibrosis of the capsular rim 22 occurs about the
spring arms to fix the lenses within the capsular bag and about the
lens haptics to form pockets in which the haptics slide when they
flex during accommodation of the lenses.
Referring to FIG. 32 and to FIGS. 4 to 8, projections such as those
indicated at 286 in FIG. 32, may preferably be provided in various
embodiments of the invention to space the capsulorhexis from the
optic when the capsulorhexis constricts from its configuration
shown in FIGS. 5 to 8. This spacing prevents the anterior capsular
rim 22, with a relatively small capsular opening 26, from
encroaching onto the optic during fibrosis of capsular rim 22. As
shown in FIG. 32, such projections 286 extend outwardly anteriorly
from the plate haptic surface, and are disposed about and spaced
from the optic. The projections extend outwardly no farther than
the outer extent of the optic, typically to a height of about 1-1.5
mm. The projections may be in the form of continuous arcs (not
shown) and may be inclined outwardly relative to the optic.
The modified accommodating intraocular lens 290 of FIG. 33
comprises a circular optic 292 and two pairs 294, 296 of curved,
flexible haptics 298, 300 extending from opposite edges of the
optic. These haptics have the form of relatively slender arms. At
the outer ends of the haptics are enlarged knobs 302. The two
haptics 298 of each haptic pair 294, 296 extend out from the optic
292 in mutually divergent relation and curve away from one another
toward their outer ends, as shown. The four haptics are disposed in
symmetrical relation relative to a plane of symmetry containing the
axis of the optic and passing midway between the two haptics of
each haptic pair. The two haptics 298 are located diametrically
opposite one another, and the two haptics 300 are located
diametrically opposite one another. The diametrical distance
measured between the outer ends of the diametrically opposed
haptics 298, 300 is made slightly greater than the maximum diameter
of capsular bag 20. The lens 290 is implanted within the bag in
much the same manner as the earlier embodiments of the invention
and with the outer ends of the lens haptics 298, 300 disposed
between the anterior capsular rim 22 and posterior capsule 24 of
the bag. The outer ends of the haptics press resiliently against
the outer circumference of the bag and flex or bend in such a way
as to both accommodate bags of different diameter and center the
optic 292 behind the anterior capsulotomy in the bag. The anterior
capsular rim 22 of the bag fibroses about the haptics to fixate the
lens in the bag. After fibrosis is complete, brain initiated
relaxation and constriction of the ciliary muscle 28 of the eye is
effective to cause accommodation of the lens between near and
distant vision positions in essentially the same manner as
described earlier. During this accommodation, the lens buckles and
the haptics flex anteriorly and posteriorly relative to the optic
292 in much the same way as described earlier. Fibrosis of the
capsular rim about the haptic knobs 302 fixates the lens in the
capsular bag and against dislocation in the event a tear or
capsulotomy is formed in the posterior capsule 24 of the bag.
The modified accommodating intraocular lens 310 of FIG. 34 is
similar to the lens 290 of FIG. 33 and differs from the lens 290
only in the following respects. The four haptics 312, 314 of the
lens 310, rather than being slender curved arms like those of lens
290, are symmetrically tapered from relatively wide inner ends
which are joined to the lens optic 316 to relatively narrow outer
ends. At the outer ends of the haptics 312, 314 are enlarged knobs
318. At inner ends of the haptics are grooves 320 which form
flexible hinges 322 about which the haptics are flexible anteriorly
and posteriorly of the optic. The diametrical distance between the
outer ends of the diametrically opposed haptics 312, 314
approximates or slightly exceeds the maximum diameter of the
capsular bag 20. The lens 310 is implanted within the bag, and
fibrosis of the anterior capsular rim 22 of the bag occurs about
the lens haptics in the same way as described in connection with
lens 290. After fibrosis is complete, brain initiated relaxation
and constriction of the ciliary muscle 28 of the eye cause
accommodation of the lens in the same manner as described in
connection with lens 290. Fibrosis of the capsular rim about the
haptic knobs 318 fixates the lens in the capsular bag and against
dislocation in the event a tear or capsulotomy is formed in the
posterior capsule 24 of the bag.
The accommodating plate haptic lenses described to to this point
are referred to herein as simple plate haptic lenses. These lenses
are intended for use when the capsulorhexis procedure performed on
the eye is a properly performed continuous tear capsulotomy which
provides an anterior annular capsular remnant or rim that remains
intact and circumferentially continuous throughout fibrosis and has
a sufficient radial width to retain the lens in the proper position
within the capsular bag during and/or fibrosis. According to
another of its aspects, this invention provides modified
accommodating intraocular lenses, illustrated in FIGS. 38-40 and
43-46 and referred to as plate haptic spring lenses, for use when
the anterior capsular remnant or rim of the capsular bag is
ruptured, that is cut or torn, or has too small a radial width to
firmly retain the lens in proper position during and/or after
fibrosis.
As noted earlier, a ruptured capsular remnant or rim may occur in
different ways. For example, continous tear circular capsulorhexis
(FIG. 35) involves tearing the anterior capsule of the natural lens
along a circular tear line to form in the anterior capsule a
circular opening or capsulotomy 400 circumferentially surrounded by
an annular remnant or rim 402 of the anterior capsule. Improper
performance of this capsularhexis can easily create slits or tears
404 in the capsular rim. A beer can or can opener capsulorhexis
(FIG. 36) involves piercing the anterior capsule of the natural
lens at a multiplicity of close positions 404 along a circular line
and removing the circular portion of the anterior capsular rim
within the pierced line to form an anterior capsulotomy 406
circumferentially surrounded by an annular rim 408. While this rim
may be initially intact and circumferentially continuous, it has an
inner scalloped edge 410 having stress-inducing regions that render
the rim very prone to tearing radially, as shown at 411, during
surgery or subsequent fibrosis. An envelope capsulorhexis (FIG. 37)
involves slitting the anterior capsule of the natural lens along a
horizontal line 412, then along vertical lines 414 extending
upwardly from and intersecting the horizontal slit, and then
tearing the anterior capsule along a tear line 416 which arches
upwardly from the upper end of the vertical slit and then extends
vertically downward to join the second vertical cut. This
capsulorhexis produces an anterior capsulotomy 418 bounded by a
capsular remnant 420 which is slit at 412 and hence is inherently
ruptured.
A ruptured anterior capsular remnant or rim may preclude
utilization of a dimple plate haptic lens of the invention for the
following reasons. A ruptured rim may not firmly retain the lens
haptics in the sulcus of the capsular bag during fibrosis. This
renders the lens prone to decentration and/or dislocation, such as
dislocation into the vitreous cavity if the posterior capsule tears
or becomes cloudy over a period of time and is cut with a laser to
provide a capsulotomy in the posterior capsule. A ruptured capsular
rim may be incapable of assuming the taut trampoline-like condition
of an intact capsular rim. As a consequence, a ruptured capsular
rim may be incapable of effecting full posterior deflection of a
plate haptic lens to a distant viewing position against the
posterior capsule during and after fibrosis. A ruptured capsular
rim may also permit anterior deflection of the lens during
fibrosis. In either case, since the power of an intraocular lens is
selected for each individual patient and may be dependent upon
their spectacle power and since good vision without glasses
requires the lens optic to be situated at precisely the correct
distance from the retina throughout the range of accommodation, a
simple plate haptic lens of the invention may not be acceptable for
use with a ruptured anterior capsular remnant or rim.
FIGS. 38-40 illustrate an accommodating plate haptic spring
intraocular lens 420 of the invention for use with a ruptured
anterior capsular remnant or rim, such as any one of those
illustrated in FIGS. 35-37. This plate haptic spring lens has a
lens body 422 proper similar to that of the plate haptic lens 32 in
FIGS. 1-8 and springs 424 at the ends of the body. The lens body
422 includes a central optic 426 and flexible plate haptics 428
extending outward from diametrically opposite sides of the optic.
These haptics are joined to the optic by hinges 429 formed by
grooves in the anterior side of the lens. The springs 424 are
resilient loops which are staked at one end to the ends of the
haptics 428 at opposite sides of the longitudinal centerline of the
body. These spring loops bow outwardly lengthwise of the lens body
from their staked ends to their centers and then turn back toward
the lens body from their centers to their free ends. The ends of
the haptics 428 have recesses 430 over which the spring loops
extend in such a way that the loops and the edges of the recesses
form openings 432 therebetween. The ends of the spring loops have
holes 433 to receive instruments for positioning the lens in the
eye.
The plate haptic spring lens 420 is implanted within the capsular
bag 20 of the eye in the same manner as described earlier in
connection with the simple plate haptic lenses of the invention.
That is to say, the lens 420 is implanted within the eye while its
ciliary muscle 28 is paralyzed in its relaxed state, and the
capsular bag is thereby stretched to its maximum diameter (9-11
mm). The overall length of the lens body 422 measured between the
ends of the lens haptics 428 at either side of the haptic recesses
430 substantially equals the inner diameter of the stretched
capsular bag. The overall length of the lens measured between the
outer edges of the spring loops 424 at their centers when the loops
are in their normal unstressed state is slightly greater than this
inner diameter of the stretched capsular bag. For example, if the
inner diameter of the stretched capsular bag is in the range
10-10.6 mm, the lens body 422 will have an overall length of
10-10.6 mm measured between the outer ends of the lens haptics, and
the overall length of the lens measured between the centers of the
unstressed spring loops will be in the range of 11-12.5 mm.
FIGS. 39 and 40 illustrate the plate haptic spring lens 420
implanted in a capsular bag 20 which is stretched by relaxation of
the ciliary muscle 28 and has a torn anterior capsular rim 22i such
as might result from an improperly performed continuous tear
circular capsulorhexis. Because the rim is torn, the lens body 422
will not fit as snugly in the stretched bag as it would if the
capsular rim were an intact rim free of tears. The haptic spring
loops 424, however, press outward against the wall of the capsular
bag sulcus about the rim of the bag to fixate the lens in the bag
during fibrosis following surgery. Fibrosis of the torn capsular
rim 22 occurs about the outer ends of the plate haptics 428, about
the spring loops 424, and through the openings 432 between the
loops and the ends of the haptics in such a way as to effect fusion
of the torn rim, or more precisely the remnants of the torn rim, to
the posterior capsule 24 of the capsular bag. The outer ends of the
haptics and the spring loops are thereby shrink-wrapped by fibrosis
in somewhat the same manner as explained earlier in connection with
the simple plate haptic lenses of the invention. Even though the
torn capsular rim 22 may be incapable of stretching to the taut
trampoline condition discussed earlier when the ciliary muscle is
relaxed, this shrink-wrapping of the lens during fibrosis of the
torn rim will firmly fixate the lens in the capsular bag and should
cause some posterior deflection of the lens against the elastic
posterior capsule 24. Accordingly, brain-induced constriction and
relaxation of the ciliary muscle 28 after fibrosis of the torn
capsular rim is complete should effect accommodation of the plate
haptic spring lens in much the same way, but possibly not with the
same amount of accommodation, as the simple plate haptic lens with
an intact non-ruptured capsular rim.
While the plate haptic spring lens 420 is designed for use with a
ruptured anterior capsular remnant or rim, it can also be utilized
with an intact rim. A plate haptic spring lens also compensates for
improper lens placement in the eye with one end of the lens
situated in the capsular bag and the other end of the lens situated
in the ciliary sulcus of the eye since the spring loops will expand
outwardly to engage both the inner edge of the bag and the wall of
the ciliary sulcus. In this regard, an advantage of the plate
haptic spring lenses of the invention over the simple plate haptic
lenses resides in the fact that the spring lenses eliminate the
need to have on hand in the operating room both a simple plate
haptic lens for use with an intact capsular rim and a plate haptic
spring lens as a backup for the plate haptic lens in the event the
rim is ruptured during surgery.
Another advantage of the haptic spring lens 420 resides in the fact
that it permits the lens to have a larger optic than a simple plate
haptic lens whose optic diameters will normally be within the range
of 4-7 mm. Thus, since the haptic spring lens relies on the spring
loops 424 rather than on the capsular remnant or rim 22 to retain
the lens in position during fibrosis, the lens may be used with a
capsular remnant or rim of smaller radial width and hence larger
capsulotomy diameter than those required for use of the simple
plate haptic accommodating lenses. The larger capsulotomy, of
course, permits a larger optic diameter in the range of 7-9 mm
which offers certain ophthalmological benefits.
The large capsulotomy necessary to accommodate a large optic spring
accommodating lens may be formed during the original surgery by a
planned large continuous tear circular capsulorhexis, a beer can
capsulorhexis of the desired large diameter, a planned envelope
capsulotomy or the cutting of radial slits into a small continuous
tear capsulotomy during surgery after implanting the spring
accommodating lens. According to another of its aspects, the
invention provides a method whereby the desired large anterior
capsulotomy may be formed after the original surgery following
completion of fibrosis. This method involves slitting an annular
capsular rim radially with a laser after fibrosis is complete into
a number of flap-like remnants 434 (FIG. 41) which are easily
displaced by the lens during accommodation to enlarge the
capsulotomy sufficiently to permit the lens optic to pass through
the capsulotomy. Alternatively, the capsulotomy may be enlarged by
cutting the capsular rim with a laser circumferentially along a
circular line 436 (FIG. 42) concentric with and radially outwardly
of the original edge of the capsulotomy to enlarge the latter.
The modified plate haptic spring lens 500 of FIG. 43 is identical
to the lens 420 just described except that the haptics 502 of the
modified lens, rather than being hinged to the lens optic 504, are
resiliently flexible throughout their length like those of the
plate haptic lens in FIG. 9. FIG. 44 illustrates a further modified
plate haptic spring lens 600 according to the invention which is
identical to the lens 420 except that the spring loops 602 of the
modified lens are formed integrally with the lens haptics 604. The
modified lens 700 and 800 of FIGS. 45 and 46 are identical to the
lens 600 except that the modified lenses have a pair of spring
loops at each end. The spring loops 702 of lens 700 have common
base portions 704 integrally joined to the ends of the lens haptics
706 along the longitudinal centerline of the lens and free ends
which curve outwardly from the base portions both endwise and
laterally of the lens. The spring loops 802 of lens 800 have base
portions 804 integrally joined to the ends of the lens haptics 806
along the longitudinal edges of the haptics and opposite free ends
which curve inwardly toward one another laterally of the lens.
Thus there has been shown and described a novel accommodating
intraocular lens which fulfills all the objects and advantages
sought therefor. Many changes, modifications, variations and other
uses and applications of the subject invention will, however,
become apparent to those skilled in the art after considering this
specification together with the accompanying drawings and claims.
All such changes, modifications, variations and other uses and
applications which do not depart from the spirit and scope of the
invention are deemed to be covered by the invention which is
limited only by the claims which follow.
* * * * *